Rehabilitation Research in the Burn Center

Nintendo® Wii™ Video Game System May Help Burn Survivors Increase Mobility

New York(Mar 12, 2010)

Children (and adults) around the world have been enjoying the sports and other games that can be played as part of the Nintendo® Wii™ video game system. Now researchers at the William Randolph Hearst Burn Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center are finding that the system may be a new tool for burn survivors to increase their mobility while letting them have a little fun – a process they have dubbed "Wii-habilitation."

Such "virtual therapy" is part of robust array of research projects under way at the Burn Center, thanks to generous funding from donors such as the New York Firefights Burn Center Foundation. Investigators are also developing consensus guidelines for burn rehabilitation and assessing staff perceptions and practice of recommended therapies in an effort to improve outcomes.

Established in 1976, the Burn Center team includes occupational and physical therapists, surgeons, nurses, recreation specialists, social workers, nutritionists, pharmacists, and other staff whose shared goal is to begin treating patients with burns as soon as possible to maximize their healing and rehabilitation – especially in the period up to the first two years after a burn, during which time the scar matures. NewYork-Presbyterian Hospital/Weill Cornell Medical Center's Department of Rehabilitation Medicine works in partnership with the Burn Center.

Burn Center rehabilitation therapy staff have devised novel treatments to be used from head to toe – ranging from lightweight, conformable, and breathable masks to treat facial burns to a circular suspension system that preserves ankle range of motion and soft tissue integrity for patients with heel burns.

Virtual Therapy to Restore Mobility and Confidence

Pain during therapy may hamper the mobility of some patients, which increases their risk of contracture. Therapists are evaluating the use of certain Wii games to improve mobility while reducing anxiety and pain. Prior research has shown that the enjoyment a patient experiences while playing a video game may be a useful distraction from the pain enabling them to achieve greater functional mobility.

Therapists at the William Randolph Hearst Burn Center at NewYork-Presbyterian/Weill Cornell find that Wii Sports™ Baseball may help increase mobility in the shoulder joint, while Wii Fit™ Ski Jumping improves range of motion in the knees and hips. A randomized controlled clinical trial is under way to assess the efficacy of this approach in burn patients.

"Virtual therapy is an adjunct to enhance the therapeutic experience, not replace it," said Delia Gorga, PhD, OTR/L,. "Our researchers want to determine if a virtual therapeutic approach can 'submerge' the patient in another place, enabling them to enjoy therapy during what would otherwise be an uncomfortable experience."

Some patients recovering from kitchen burns are also involved in such research. Medical literature supports simulating activities of daily living and group activity as effective treatments during burn rehabilitation. Patients can participate in cooking groups in the kitchen located in the Burn Center that may help them overcome their anxiety of the kitchen environment. They also play the Wii "Cooking Mama Cook-Off" video game as part of their therapy – a virtual cooking environment which encourages them to perform mobility-promoting motions such as stirring, cutting, and chopping.

Researchers are comparing the outcomes of the real versus virtual cooking groups. They hypothesized that virtual cooking would provide a transition to actual cooking, especially for patients who were not physically able or were apprehensive about cooking activities in the kitchen after sustaining a burn injury.

"The virtual therapy approach might be a good way to wean patients back into the kitchen," noted Sam K. Yohannan, PT, MS. "It also may present a therapeutic option for burn centers that do not have real kitchens on-site."

Building a Consensus

Burn Center researchers have also been electronically surveying physical and occupational therapists at burn centers across the country to assess their practices. "The data we are gathering will provide a consensus for practices and protocols for burn rehabilitation," said Mr. Yohannan.

For example, he and his fellow investigators have examined trends in methods and length of immobilization, criteria for mobilization, weight bearing status, and ambulation following lower extremity skin grafting, and current protocols and trends in the United States and Canada following Integra™ placement. They also surveyed patients at the recent World Burn Congress to understand the efficacy of burn therapy interventions from the retrospection of burn survivors. The researchers plan to present the results of this and other research at the 2010 meeting of the American Burn Association.

Perception Versus Practice

It's critical that burn patients wear prescribed splints to increase their range of motion and promote scar healing. The perceptions and practice of nursing and therapy staff regarding patients' wearing of their splints were investigated and analyzed. "We have to be aggressive and consistent with splint treatment within the two-year window, or a burn scar can develop into a contracture," noted Dr. Gorga. Bridging the disparity between perception and practice will ultimately impact the recovery of the burn patient through improved collaborative care.

Staff Contributing to this Article:

Delia Gorga, PhD, OTR/L, is the Administrative Director for the Department of Rehabilitation Medicine at
NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Sam K. Yohannan, PT, MS, is a Senior Physical Therapy Specialist of Research in the Burn Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.